Langenbeck's Archives of Surgery

, Volume 402, Issue 6, pp 949–955 | Cite as

Prevention of parastomal hernia in the emergency setting

  • Anna Lykke
  • Johnny F. B. Andersen
  • Lars N Jorgensen
  • Tommie Mynster
ORIGINAL ARTICLE
First Online:
Received:
Accepted:
  • 211 Downloads

Abstract

Aim

This study assessed safety and efficacy associated with hernia prophylaxis using a retromuscular slowly resorbable synthetic mesh for stoma reinforcement.

Method

This was a cohort study with a historic reference group. The study took place in a high-volume surgical department. During a 2-year period (July 2012–July 2014), we included 109 patients undergoing emergency surgery with formation of ileostomy or colostomy. All patients received a retromuscular slowly resorbable synthetic mesh (TIGR®, Novus Scientific) at the stoma site. The reference group included 117 patients who underwent emergency stoma formation without a prophylactic mesh in the 2-year period prior to July 2012. The primary endpoint was effect on prevention of parastomal hernia within 1 year. Secondary endpoints were 30-day and 1-year complications including mortality.

Results

The operative field was contaminated or dirty in 48% of the procedures. Operative time was significantly longer in the mesh group. The cumulative incidences of parastomal hernia at 1 year for the control and the mesh group were 8 and 7% (p = 0.424), respectively. The postoperative 30-day and 1-year rate of complications, reoperations and mortality were not different between the two groups. No patients underwent removal of the mesh and no clinical mesh infections were seen.

Conclusion

Use of a resorbable synthetic mesh during emergency ostomy formation showed no significant preventive effect on formation of parastomal hernia after 1 year. Although surgery was often conducted in a severely contaminated field, the procedure was without significantly increased complication rate.

Keywords

Ostomy Parastomal hernia Mesh Complications Emergency surgery 
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Notes

Acknowledgements

The authors thank ostomy nurses Mette von Rosen and Trine Borglit for the collection of data and Mr. Neil J Smart, Consultant Colorectal Surgeon at the Royal Devon and Exeter Hospital, for the valuable comments and revision of the manuscript. Novus Scientific, Uppsala, Sweden, provided the TIGR® mesh material for this study.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

The study was approved by the Danish Data Protective Agency (J.nr. 2012-41-0566). Because the study design was descriptive and monitored current routine practice in the department, no approval of the study was required from the local ethical review board.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2017

Authors and Affiliations

  1. 1.Digestive Disease Center, Bispebjerg HospitalUniversity of CopenhagenCopenhagenDenmark
  2. 2.Department of Radiology, Bispebjerg HospitalUniversity of CopenhagenCopenhagenDenmark

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